Frozen shoulder

Frozen shoulder, or adhesive capsulitis, develops when the capsule of tissue surrounding the shoulder joint becomes inflamed, thickened and tight. This loss of normal stretch is what limits movement and drives the pain, and it explains why the shoulder feels mechanically restricted rather than simply sore.

In many people there is no obvious trigger, and it can begin out of the blue. In others it follows a spell when the shoulder has been kept still, for example after an injury, an operation or another painful shoulder condition such as rotator cuff problems.

It is most common between the ages of about 40 and 60, slightly more so in women, and is notably more frequent in people with diabetes or thyroid conditions.

Frozen shoulder typically follows a pattern of stages. Features include:

• Shoulder pain that develops gradually, often worse at night
• Increasing stiffness and a reducing range of movement
• Difficulty with everyday actions such as reaching up or behind the back
• A later phase in which movement slowly returns

Frozen shoulder can usually be recognised from the history and a careful examination of the shoulder's movement. Part of the assessment is making sure the symptoms are not due to another shoulder problem, as this guides the right treatment.

Ultrasound can help assess the shoulder and exclude other causes of pain and stiffness. Dr Borukhson uses point-of-care ultrasound during the consultation, so the shoulder can often be examined in the same visit. You can read more on the ultrasound clinic page. Where she judges another type of imaging to be more appropriate, such as an MRI, she will refer for it, and at times both ultrasound and MRI are needed together to build a complete picture.

The aims are to relieve pain and restore movement. Treatment usually combines a structured programme of exercises to maintain and recover movement with measures to control pain. Where pain is limiting progress, an ultrasound-guided injection into the shoulder can be very helpful, and performing it under ultrasound guidance helps place it accurately. The plan is agreed with you.

Gentle, regular movement matters more than rest. Keeping the shoulder as active as the pain reasonably allows, and following any exercises you have been given, helps protect the range you still have rather than letting stiffness settle further.

• Use heat before exercising and try to move little and often through the day
• Adjust how you sleep, as lying on the affected side often disturbs nights
• Keep up everyday tasks within comfort rather than guarding the arm completely

It helps to know that frozen shoulder is self-limiting: it moves through painful, stiff and then easing stages, and most shoulders recover good function, though this commonly takes a year or more. Pacing yourself and keeping appointments to review progress makes that long course far easier to live with.

Frozen shoulder itself is not dangerous, but certain features point away from it and deserve prompt review rather than waiting:

• Shoulder pain that follows a fall or injury, or a feeling the joint has slipped out of place
• A shoulder that looks visibly deformed, or arm weakness, numbness or pins and needles
• Marked redness, swelling, warmth or a fever, which can suggest infection
• Night pain with unexplained weight loss or feeling generally unwell

Seek same-day care for these. For more routine concerns, arrange a review if pain is poorly controlled, sleep is badly affected, or stiffness is not improving despite doing your exercises, so the diagnosis can be confirmed and the plan adjusted.

A painful, stiff shoulder is worth assessing to confirm the diagnosis, exclude other causes, and put in place a plan that eases symptoms and supports recovery rather than simply waiting it out. If your shoulder has become painful and stiff, a specialist review can help.

How is frozen shoulder diagnosed?

Frozen shoulder can usually be recognised from your history and a careful examination of how the shoulder moves. Part of the assessment is making sure the pain and stiffness are not coming from another shoulder problem, as this guides the right treatment. Dr Borukhson uses point-of-care ultrasound during the consultation, so the shoulder can often be examined in the same visit, and she will arrange other imaging such as an MRI where that is more appropriate.

Will a frozen shoulder go away on its own?

Frozen shoulder does tend to improve with time, but the process moves through stages and can be slow and uncomfortable over many months. Treatment does not just pass the time: it aims to ease pain and help movement return rather than simply waiting it out. A specialist assessment can confirm the diagnosis and put a plan in place to support recovery.

Do I need surgery for a frozen shoulder?

Most people with frozen shoulder do not need surgery. The usual approach combines a structured exercise programme to maintain and recover movement with measures to control pain, and where pain is holding back progress an ultrasound-guided injection into the shoulder can be very helpful. The plan is agreed with you and reviewed as the shoulder settles.

Why does an ultrasound-guided injection help, and is it better than a plain injection?

Where pain is the main thing limiting movement and progress, an injection into the shoulder can settle it and make the exercises easier to do. Performing the injection under ultrasound guidance helps place it accurately, which is why Dr Borukhson uses it. The decision on whether an injection is right for you is made together as part of your overall plan.